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Ohta Y, Sugama R, Minoda Y, Mizokawa S, Takahashi S, Ikebuchi M, Nakatsuchi T, Nakamura H. Highly Porous Titanium Cups Frequently Presenting with Radiolucent Lines in Cementless Primary Total Hip Arthroplasty: A Retrospective Cohort Study. J Clin Med 2024; 13:3297. [PMID: 38893007 PMCID: PMC11173321 DOI: 10.3390/jcm13113297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/30/2024] [Accepted: 06/01/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: A highly porous titanium cup with a three-dimensional metal interface was recently introduced to improve biological fixation and survival. However, radiography has revealed concerns regarding these cups, despite their excellent short- and mid-term clinical outcomes. This study compared the clinical and radiographic results of a highly porous titanium cup with those of a hydroxyapatite-coated porous titanium cup after primary total hip arthroplasty (THA). Methods: Fifty-one primary THAs were investigated. A highly porous titanium cup was used in 17 hips, and a hydroxyapatite-coated porous titanium cup was used in 34 hips. No significant differences in preoperative patient demographic characteristics were observed between the two groups. The 2-year postoperative clinical and radiographic results were compared. Results: Radiolucent lines were observed in 13 (76%) of 17 hips with highly porous titanium cups and in none (0%) of 34 hips with hydroxyapatite-coated porous titanium cups (p < 0.001). In the highly porous titanium cup group, radiolucent lines were observed in five hips (29%) in one zone, two hips (11%) in two zones, and six hips (35%) in three zones. No cup loosening was observed in either group. Conclusions: Radiolucent lines were significantly more frequent in highly porous titanium cups. This study suggests that, compared to the three-dimensional structure of porous titanium, the hydroxyapatite coating of porous titanium had a greater influence on bone ingrowth in the short term. The meaning of these findings in the long-term is unclear yet.
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Affiliation(s)
- Yoichi Ohta
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
| | - Ryo Sugama
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
| | - Shigekazu Mizokawa
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
| | - Mitsuhiko Ikebuchi
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
| | - Tamotsu Nakatsuchi
- Tsuji-geka Rehabilitation Hospital, 3-24 Ikutamamaemachi, Tennnouji-ku, Osaka 543-0072, Japan;
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
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Takayama K, Ito H. Both angled bony-increased offset and metal-augmented baseplates provide satisfactory bone incorporation to the glenoid in reverse total shoulder arthroplasty: a radiographic evaluation using tomosynthesis. J Shoulder Elbow Surg 2024; 33:1058-1067. [PMID: 37848155 DOI: 10.1016/j.jse.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/17/2023] [Accepted: 09/03/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Angled bony-increased offset and metal-augmented baseplate have recently been used to achieve neutral to inferior inclination of the glenoid implant. Nonetheless, bone incorporation is difficult to evaluate using computed tomography or other conventional methods owing to the presence of metal artifacts; therefore, whether bone incorporation between the grafted bone and glenoid or between the graft and baseplate implant can be achieved remains unclear. Several studies have reported the effectiveness of tomosynthesis in reducing metal artifacts for the evaluation of implant loosening, bone resorption, and spot welds. We aimed to evaluate and compare the bone incorporation rates between angled bony-increased offset and metal-augmented implants using tomosynthesis with metal artifact reduction technology. We hypothesized that a high bone incorporation rate would be obtained with angled bony-increased offset and a metal-augmented baseplate. METHODS A total of 52 patients who underwent reverse total shoulder arthroplasty (TSA) with angled bony-increased offset and 42 patients who underwent reverse total shoulder arthroplasty with metal-augmented baseplate were assessed and followed up for a minimum of 2 years. The bone incorporation and implant loosening rates were compared between the 2 groups, and the sites of spot welds and trabeculation were recorded according to zones. Bone incorporation between the bone and prosthesis was defined as a confirmation of spot welds connecting the porous area and bone in more than three zones. Bone incorporation between the native bone and grafted bone was defined as an observation of trabeculation. Glenoid loosening was defined as the presence of at least 1 mm radiolucency around the prosthesis in more than 2 zones. RESULTS Both the angled bony-increased offset and metal-augmented baseplate groups achieved sufficient bone incorporation rates (98% [51/52 cases] vs. 100% [42/42 cases], P = 1.0) and low implant loosening rates (2% [1/52 cases] vs. 0% [0/42 cases], P = 1.0). Spot welds and trabeculation were likely to be confirmed in the lower parts of the glenoid. CONCLUSION The two groups did not show any significant differences regarding bone incorporation rates. Considering the complexity of performing the procedure with angled bony-increased offset, the use of a metal-augmented baseplate can serve as an alternative treatment to avoid superior inclination in reverse total shoulder arthroplasty.
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Affiliation(s)
- Kazumasa Takayama
- Department of Orthopaedics, Kurashiki Central Hospital, Okayama, Japan.
| | - Hiromu Ito
- Department of Orthopaedics, Kurashiki Central Hospital, Okayama, Japan
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Tamaki R, Wada K, Inoue T, Doi T, Okazaki K. Reliability and head-loading effects in imaging diagnosis of vertical subluxation in patients with rheumatoid arthritis. Mod Rheumatol 2024; 34:488-492. [PMID: 37210211 DOI: 10.1093/mr/road044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/18/2023] [Accepted: 05/08/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES The purpose of this study was to examine the reproducibility of vertical subluxation (VS) parameters using X-ray, computed tomography (CT), and tomosynthesis (TS) while comparing the head-loading effects. METHODS The VS parameters of 26 patients (retrospective review) were evaluated. Using the intra-class correlation coefficient, we statistically examined the intra-rater and inter-rater reliabilities of the parameters. Head-loaded and -unloaded imagings were compared using a Wilcoxon signed-rank test. RESULTS The intra-rater reliability of TS and CT showed intra-class correlation coefficients of ≥0.8 (X-ray range: 0.6-0.8), with similar results for the inter-rater reliabilities. Furthermore, in head-loading imaging, the TS had significantly higher VS scores than that of CT (P < .05). CONCLUSIONS In comparison with the X-ray, TS and CT were more accurate and reproducible. In terms of head loading, the VS values for TS were worse than those for CT, indicating that TS was more effective than CT in diagnosing VS.
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Affiliation(s)
- Ryo Tamaki
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
| | - Keiji Wada
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
| | - Tomohisa Inoue
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
| | - Toru Doi
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
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Familiari F, Barone A, De Gori M, Banci L, Palco M, Simonetta R, Gasparini G, Mercurio M, Calafiore G. Short- to Mid-Term Clinical and Radiological Results of Selective Laser Melting Highly Porous Titanium Cup in Primary Total Hip Arthroplasty. J Clin Med 2024; 13:969. [PMID: 38398281 PMCID: PMC10889807 DOI: 10.3390/jcm13040969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: The aim of this study was to evaluate short- to mid-term clinical and radiological results in patients undergoing primary total hip arthroplasty (THA) with the use of a Selective Laser Melting 3D-printed highly porous titanium acetabular cup (Jump System Traser®, Permedica Orthopaedics). (2) Methods: We conducted a retrospective study and collected prospective data on 125 consecutive patients who underwent primary THA with the use of highly porous titanium cup. Each patient was evaluated preoperatively and postoperatively with a clinical and radiological assessment. (3) Results: The final cohort consisted of 104 patients evaluated after a correct value of 52 (38-74) months. The median Harris Hip Score (HHS) significantly improved from 63.7 (16-95.8) preoperatively to 94.8 (38.2-95.8) postoperatively (p < 0.001), with higher improvement associated with higher age at surgery (β = 0.22, p = 0.025). On postoperative radiographs, the average acetabular cup inclination and anteversion were 46° (30°-57°) and 15° (1°-32°), respectively. All cups radiographically showed signs of osseointegration with no radiolucency observed, or component loosening. (4) Conclusions: The use of this highly porous acetabular cup in primary THA achieved excellent clinical, functional, and radiological results at mid-term follow-up. A better clinical recovery can be expected in older patients. The radiological evaluation showed excellent osseointegration of the cup with complete absence of periprosthetic radiolucent lines.
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Affiliation(s)
- Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy
| | - Alessandro Barone
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy
| | | | - Lorenzo Banci
- Clinical Department, Permedica Orthopaedics, 23807 Merate, Italy
| | - Michelangelo Palco
- Division of Orthopaedic and Trauma Surgery, Villa del Sole Clinic, 88100 Catanzaro, Italy
| | - Roberto Simonetta
- Division of Orthopaedic and Trauma Surgery, Villa del Sole Clinic, 88100 Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy
| | - Giuseppe Calafiore
- Clinica Città di Parma, 43123 Parma, Italy
- IRCSS Humanitas Research Hospital, 20089 Rozzano, Italy
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Kaneko T, Nakamura S, Hayakawa K, Tokimura F, Miyazaki T. Clinical and radiological outcomes of total hip arthroplasty in octogenarian patients using a three-dimensional porous titanium cup: a retrospective analysis in Japanese patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03439-0. [PMID: 36414875 DOI: 10.1007/s00590-022-03439-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Osteointegration of a three-dimensional (3D) porous titanium material has been experimentally proven, but only a few studies have shown the clinical outcomes of a 3D porous titanium cup in the Japanese elderly population. The purpose of this study was to compare the short-and-medium term clinical and radiographic results of total hip arthroplasty (THA) using a 3D porous titanium cup in patients aged ≥ 80 (octogenarians) versus those aged < 80 (younger controls). METHODS A total of 104 hips that underwent THA using a 3D porous titanium cup (SQRUM TT, Kyocera Medical) were enrolled in the study and were divided into two groups according to age: the octogenarian group (≥ 80, n = 42) and the younger control group (< 80, n = 62). Furthermore, we evaluated patient characteristics, clinical outcomes determined by the Japanese Orthopedic Association score, cup alignment, and incidence of radiolucent lines around the cup. RESULTS The mean follow-up period was 4.2 and 4.0 years (p = 0.29) for octogenarians and younger controls, respectively. The clinical outcomes were excellent, and no revision surgery occurred until the last follow-up in both groups. The number of patients with radiolucent lines at the final evaluation was 21 of 62 (33.9%) in younger controls and 16 of 42 (38.1%) in octogenarians. CONCLUSION THA with 3D porous titanium cup for octogenarians had similar clinical outcomes and incidence of radiolucent lines as those of younger controls, suggesting that the 3D porous titanium cup may be useful in THA for octogenarians. Further investigations will confirm its long-term outcomes.
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Affiliation(s)
- Taizo Kaneko
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35- 2, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Shinya Nakamura
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35- 2, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Kentaro Hayakawa
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35- 2, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Fumiaki Tokimura
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35- 2, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Tsuyoshi Miyazaki
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35- 2, Itabashi-ku, Tokyo, 173-0015, Japan.
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New Evaluation Method for Bone Formation around a Fully Hydroxyapatite-Coated Stem Using Digital Tomosynthesis: A Retrospective Cross-Sectional Study. Diagnostics (Basel) 2021; 11:diagnostics11112094. [PMID: 34829440 PMCID: PMC8623614 DOI: 10.3390/diagnostics11112094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
Digital tomosynthesis (DTS) is a new imaging technique derived from radiography, and its usefulness has been gradually reported in the field of orthopedic diagnosis in recent years. A fully hydroxyapatite (HA)-coated stem, which is used for total hip arthroplasty (THA), is a type of cementless stem that has been widely used recently and reported to have good results. However, stem loosening on plain radiographs is difficult to determine in some cases due to cancellous condensation around the stem. In this retrospective cross-sectional study, we compared the results of plain radiography versus DTS to evaluate the imaging findings after THA using a fully HA-coated stem. Twenty joints each in the 3 y and 1 y postoperative groups underwent plain radiography and DTS. On DTS, bone formation around the stem was confirmed in all cases; however, this formation was not reproducible on plain radiography, and there were cases in which the reaction could not be confirmed or cases with cancellous condensation resembling reactive lines. This reaction was not reproducible on plain radiographs, and in some cases, the reaction could not be confirmed, or there were cases with cancellous condensation that resembled reactive lines. Therefore, DTS was useful in the diagnosis of bone formation around the implant.
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